The Silos Of Healthcare

Within the past 10 years, it is very likely that you have come across the “silo” metaphor. It is now commonly used in US healthcare to describe the isolation of a resource or information from the rest of the system. I have seen the metaphor used to describe patient flow, healthcare data, and financial structures within a hospital. In all cases, the rationale behind the “silo” structured system was rarely discussed. Here is an attempt to explain why we arrived at those devisions in each of the three areas, and how moving past that approach may result in significant gains if performed correctly.

Patient Flow: In this instance, the “silo” metaphor describes individual patient care areas as islands. Each aware only of their own processes, demands, and needs but unaware of the needs outside the department. It is a common scenario encountered in the hospital setting. You can imagine a department struggling due to capacity or a sudden surge in volume. As the ability to care for patients is met or exceeded, patient flow suffers. This occurs with little involvement or awareness on behalf of other departments. Each area has surges and capacity but there is no global mechanism for communication or notification. In this instance, the departments are self aware but with little global or situational awareness at the hospital level. The best method of combatting such a system is a central information hub, one which relays information to everyone regarding the status and capabilities of every department. Such a system would increase inter-departmental cooperation. Imagine a department that has capacity lending its staff to another. Imagine nurses floating from one area to another. Imagine no one being sent home early until all departments are fully functional and running optimally. The institute for healthcare improvement has a great description of just such a system with successful deployment. You can read more about it here : IHI.org . The crux of this improvement is increasing staff awareness of the whole organization’s status instead of focusing solely on one department. Sharing information regarding needs allows for sharing of resources.

Healthcare Data: With the adoption of electronic medical records has come the availability of large amounts of healthcare data. Ideally, data would be freely shared by all healthcare organizations so that patient records followed patients. However, with the same adoption of electronic medical records came the need for increased information security. The quantity of information that could be obtained by a single breach became far greater than the previous paper era of documentation. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) legislated data privacy and security but fell short of providing necessary and specific details. Subsequent paranoia over information security and significant awards from lawsuits over data breaches led to the law being frequently misinterpreted and artificial barriers being created. In some cases, these barriers actually worsened the exchange of healthcare information between facilities and among providers. Within the past decade, the “silos” of healthcare data referred to the massive data repositories existing in hospital electronic medical records, and their smaller counterparts in physician private practices. In order to improve data “portability”, healthcare information exchanges were developed. These were helpful but difficult and costly to develop and maintain as each organization used a different electronic documentation system without a standard format for data storage. Within the past few years, companies have begun to adopt a more standardized data storage format allowing for integration across systems to occur more easily. Although it continues to be a significant problem, the “silos” in healthcare data are beginning to crumble.

Finance: This area has always lent itself to discrete budgetary or financial “silos”. Process improvement requires resources, that requires business plans, and those require a financial source. In large organizations where departmental allocations are based on the standard fiscal budget process, it can be difficult to assign new projects to willing departments. Budgetary constraints prevent departments from taking on new projects that require funding, and improvements can be stifled. These “silos” are overcome by actually improving your relationship with your financial officers (CFO). Their expertise and position allows a global view of the organization’s fiscal health. That allows resources spread across multiple budgetary areas to be re-allocated in order to find funding for special projects and improvements. But, if you don’t have that view of the organization from 10,000 feet, you will not know that such funds are actually present. So make allies of your finance department staff.

All three areas have a common theme. All are subject to microscopic views illuminating only the path directly in front of us, leading to a system with “silos”. However, stepping back, taking a wider view of your hospital and asking for assistance from those VP/C-suite executives can be helpful in finding solutions beyond your departmental walls.